Kidney and Urinary Tract Disease - Diseases (30 & 31) Flashcards Preview

Clinical Pathology > Kidney and Urinary Tract Disease - Diseases (30 & 31) > Flashcards

Flashcards in Kidney and Urinary Tract Disease - Diseases (30 & 31) Deck (216):
1

Function of the kidneys

- Eliminating metabolic waste products
- Regulating fluid and electrolyte balance
- Influencing acid-base balance
- Production of hormones (Renin, erythropoietin)

2

Function of the kidneys

- Eliminating metabolic waste products
- Regulating fluid and electrolyte balance
- Influencing acid-base balance
- Production of hormones (Renin, erythropoietin)

3

How many people develop acute renal failure in England?

26,000/year

4

Acute renal failure presentation

Rapid rise in creatinine and urea, generally unwell

5

Nephrotic syndrome presentation

Oedema, protein uria and hypoalbuminaemia, proteinuria >3g/24 hr (albumin)

6

Acute nephritis (nephritic syndrome)

Oedema, proteinuria, haematuria, renal failure

7

Chronic renal failure

Slow declining renal function

8

What part of kidney allows filtration?

Foot processes, endothelial cells and basement membrane in podocytes in glomerulus i

9

Blood flow in kidney

Renal artery > afferent arterioles > glomerulus > efferent arteriole > proximal convoluted tubule (PCT) > loop of hence > distal convoluted tubule > collecting duct/renal vein

10

Immunological causes of damage to BM

- Circulating immune complexes deposit in glomerulus
- Circulating antigens deposit in glomerulus
- Antibodies to BM/other components of glomerulus

11

Immunological causes of damage to BM damage the glomeruli via

Complement activation, neutrophil activation, reactive oxygen species, clotting factors

12

Non-Immunological causes of damage to BM > GD

- Hyperglycaemia
- Inherited disease (abnormal podocytes)
- Deposition of abnormal proteins (amyloid)

13

Non-Immunological causes of damage to vessels > GD

Injury to endothelium of vessels

14

Ischaemic mechanisms of tubular damage

Hypotension, damage to vessels within kidney, glomerular damage > reduced blood supply

15

Toxic mechanisms of tubular damage

Direct toxins, hypersensitivity reactions (to drugs), deposition of crystals in tubules (gout), deposition of abnormal proteins in tubules

16

Mechanisms of vascular damage

Hypertension, diabetes, atheroma, vasculitis, thrombotic microangiopathy (rare)

17

Vasculitis

Obliteration of lumen by inflammation, inflammation of larger arterioles > hypoxia, adults and children affected e.g. Wegener's granulomatosis

18

Thrombotic microangiopathy

Thrombi in capillaries and small arterioles, damage endothelium (bacterial toxins, drugs, abnormal clotting) e.g. haemolytic uraemic syndrome

19

Glomerular diseases

Membranous nephropathy (idiopathic)
FSGS (idiopathic)
Mesangiocapillary glomerulonephritis (idiopathic)
Minimal change disease
Post-infective glomerulonephritis
Anti-GBM disease
IgA nephropathy
Henoch-Schonlein purpura
Lupus nephritis (in SLE)

20

Cause of nephrotic syndrome

Damage to glomerulus

21

Symptoms of nephrotic syndrome

Oedema, proteinuria (>3g in 24hr), hypoalbuminaemia

(+/- hypertension, hyperlipidaemia)

22

Complications of nephrotic syndrome

Infection, thrombosis

23

Causes of nephrotic syndrome in Adults

Membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease, diabetes, lupus nephritis, amyloid

24

Membrane nephropathy

Idiopathic, adults 30-60, M>F, 20-30% progress to end stage renal failure

25

FSGS

Idiopathic, genetic, heroin use, HIV, M>F

26

Minimal change disease

More common in children, biopsy is normal on light microscopy M=F

27

Causes of nephrotic syndrome in children

Minimal change disease (most common), FSGS

28

Acute nephritis symptoms

Oedema, haematuria, proteinuria, hypertension, acute renal failure

29

Causes of acute nephritis in adults

Post-infective glomerulonephritis, IgA nephropathy, vasculitis, lupus

30

Post-infective glomerulonephritis

Occurs few weeks after streptococcal throat infection, most recover completely

31

IgA nephropathy

Most common, teenagers and young adults with haematuria, 20-50% progress to renal failure over 20 years

32

Vasculitis symptoms

Fever, generally unwell, rash, myalgia, arthralgia (fever and weight loss due to inflammation)

33

Lupus

AI disease, typically young women

34

Causes of acute nephritis in children

Post-infective glomerulonephritis (most common), IgA nephropathy, Henoch-Schonlein purport, HUS

35

Henoch-Schonlein purpura

Specific type of IgA nephropathy, M>F, young boys/teenagers with arthralgia, ab pain, rash, haematuria, acute renal failure, most recover completely

36

Haemolytic-Uraemia syndrome

Typically children with E.Coli 0157 enteritis, acute nephritis, haemolysis, thrombocytopenia, children can be v.ill

37

Diagnosis of acute renal failure

Anuria/oliguria and raised creatinine and urea

38

Treatment of acute renal failure

Short term dialysis may be needed

39

Pre-renal causes of acute renal failure

Reduced blood flow to kidney - severe dehydration, hypotension (bleeding, septic shock, LV failure)

40

Post-renal causes of ARF

Tumours of urinary tract, tumours in pelvis, bladder stones, prostatic enlargement

41

Causes of ARF in adults

Vasculitis and acute interstitial nephritis/tubulointerstitial nephritis

42

Acute interstitial nephritis/tubulointerstitial nephritis

Tubular damage with inflammation, caused by drug reactions

43

Causes of ARF in children

Henoch-Schonlein purpura, HUS (gastroenteritis), Acute interstitial nephritis

44

Complications of acute renal failure

Cardiac failure (fluid overload), arrhythmia (electrolyte imbalance K), GI bleeding, Jaundice, Infection (lung and urinary tract)

45

What is chronic renal failure?

Permanently reduced GFR - reduced number of nephrons

46

Stage 1 CRF

>90

47

Stage 2 CRF

60-89

48

Stage 3 CRF

30-59

49

Stage 4

15-29

50

Stage 5

51

Common causes of CRF in adults

Diabetes (commonest), glomerulonephritis, reflux nephropathy

52

Reflux nephropathy

Chronic reflux of urine up the ureter > repeated infections and scarring of the kidney

53

Common causes of CRF in children

Developmental abnormalities, reflux nephropathy, glomerulonephritis

54

Effects of CRF

Reduced excretion of water and electrolytes (oedema/hypertension), reduced excretion of toxic metabolites, reduced production of erythropoietin (anaemia), renal bone disease

55

Myeloma

Tumour of plasma cells, produce large amounts of Ig, accumulate in kidney and block up glomeruli/tubules (irreversible)

56

Isolated haematuria causes

IgA nephropathy, thin basement membrane disease, Alport type hereditary nephropathy

57

Alport type hereditary nephropathy

Inherited abnormalities of collagen type IV > abnormal BM in glomerulus, eye and ear problems (deafness), autosomal/X-linked

58

Isolated proteinuria

Less than nephrotic range, without haematuria, renal failure/oedema

59

Isolated proteinuria benign causes

Postural, pyrexia, exercise

60

Isolated proteinuria causes in adults

FSGS, diabetes, lupus

61

Isolated proteinuria causes in children

Henoch-Schonlein purpura, FSGS

62

Pyelonephritis

Infection of kidney

63

Acute pyelonephritis

More common in women (ascending infection), instrumentation of urinary tract, diabetes, structural abnormalities

64

Complications of acute pyelonephritis

Abscess formation

65

Chronic pyelonephritis

Associated with obstruction of urinary tract and reflex of urine up ureter

66

Complications of chronic pyelonephritis

Scarring of kidney and chronic renal failure

67

Renal artery stenosis causes

Atheroma or material dysplasia

68

Renal artery stenosis complications

Ischaemia of affected kidney, activation of RAAS > hypertension, loss of renal tissue > reduced renal function

69

Hypertension

> Thickening of vessels walls and reduction in lumen > loss of renal tubules and renal function > activation RAAS > increases hypertension

70

Diabetes

- Hyperglycaemia damages BM, becomes thicker, glomerulus > excess ECM > nodules
- Damages small vessels > ischaemia and damage to renal tubules

71

Obstruction within lumen of urinary tract

Urinary calculi, strictures, neoplasia

72

Abnormalities of wall

Neoplasia, congenital anatomical abnormalities

73

External compression

Tumour outside urinary tract, inflammatory conditions (retroperitoneal fibrosis), pregnancy

74

Functional obstruction

Neurological conditions, severe reflux

75

Complications of obstruction

Infection (cystitis, ascending pyelonephritis), stone/calculi formation, kidney damage

76

Complete obstruction (acute) leads to

- Reduction if GFR > acute renal failure
- Mild dilatation and mild cortical atrophy

77

Partial/intermitten obstruction (chronic) leads to

- Continued GFR > dilatation of pelvis and calyces
- Filtrate passes back into interstitial > compression of medulla > impaired concentrating ability

Both leads to cortical atrophy, fall in renal filtration and renal failure

78

Clinical features of acute bilateral obstruction

Pain, acute renal failure and anuria

79

Clinical features of chronic unilateral obstruction

Asymptomatic > cortical atrophy and reduced renal function

80

Clinical features of bilateral partial obstruction

Initially polyuric, progressive scarring and impairment

81

Epidemiology of renal calculi/urolithiasis

7-10% population, male, 20-30

82

Pathogenesis of renal calculi

- Excess of substances precipitate out
- Change in urine constituents
- Poor urine output (supersaturation)
- Decreased citrate levels

83

Calcium stones form because

Hypercalcaemia (bone disease, PTH excess, sarcoidosis), excessive absorption of intestinal Ca, inability to reabsorb tubular Ca, idiopathic, gout, hyperoxaluria (excess dietary intake)

84

What are calcium stones formed of?

Calcium oxalate/phosphate

85

Struvite stones form because

Urease producing bacterial infection (increase pH - ammonia), precipitation of magnesium, ammonium, phosphate salts

86

Characteristics of struvite stones

Large staghorn calculi

87

Urate stones form because

Hyperuricaemia (gout/patient with high cell turnover -leukaemia), idiopathic

88

Cystine stones form because

Inability of kidneys to reabsorb amino acids (rare)

89

Investigations for renal calculi

Non-contrast CT, USS, IV urography

90

Complications of stones

Obstruction, haematuria, infection, squamous metaplasia (SCC)

91

Vast majority or renal carcinomas are

Clear cell (papillary and chromophobe)

92

Peak age for renal cell carcinoma

65-80

93

Male/female more likely to get renal cell carcinoma?

Male > female (3:2)

94

Risk factors for renal cell carcinoma

Tobacco (main), obesity, hypertension, oestrogen, acquired cystic kidney disease (chronic renal failure), asbestos exposure

95

Von Hippel-Lindau syndrome

Most common cancer syndrome in RCC, VHL gene required for breakdown of hypoxia inducible factor-1 (HIF-1) oncogene, loss of gene function > cell growth and increased cell survival

96

Where do tumours develop in Von Hippel-Lindau syndrome

Kidneys, blood vessels, pancreas

97

Presentation of RCC

Haematuria, palpable abdominal mass, costovertebral pain, paraneoplastic syndromes

98

Paraneoplastic syndrome

Clinical syndrome caused by tumours, not related to the tissue that tumour arose from, not related to invasion by tumour itself/metastases

99

3 paraneoplastic syndromes associated with RCC

- Cushing's syndrome (ACTH)
- Hypercalacaemia (PTH related peptide)
- Polycthaemia (eryhtropoietin)

100

Morphology of RCC - clear cell

Well defined, yellow tumours, haemorrhagic areas, > perinephric fat/into renal vein

101

Morphology of RCC - papillary

More cystic, more likely to be multiple

102

Microscopy of RCC - clear cell

Clear cells, dedicated vasculature, small bland nuclei

103

Microscopy of RCC - papillary tumours

Cuboidal, foamy cells, surrounding fibrovascular cores, containing foamy macrophages/calcium

104

Prognosis of RCC

5yr survival 45%, organ confined >70%, tumours in perinephric fat/renal vein 50%

105

Urothelial cell carcinoma

95% bladder tumours, arising from specialised multilayered epithelium, may arise renal pelvis > urethra

106

Urothelial cell carcinoma risk factors

Age, male, carcinogens (smoking, arylamines, cyclophosphamide, radiotherapy)

107

Urothelial cell carcinoma presentation

HAEMATURIA, urinary frequency, pain on urinary, urinary tract obstruction

108

Histological patterns of Urothelial cell carcinoma

1. Papilloma-papillary carcinoma
2. Flat non-invasive carcinoma
3. Invasive papillary carcinoma
4. Flat invasive carcinoma

109

Urothelial cell carcinoma prognosis

Recurrences are common, low grade 98% still alive at 5 years, stage muscle invasions 60%

110

How many people develop acute renal failure in England?

26,000/year

111

Acute renal failure presentation

Rapid rise in creatinine and urea, generally unwell

112

Nephrotic syndrome presentation

Oedema, protein uria and hypoalbuminaemia, proteinuria >3g/24 hr (albumin)

113

Acute nephritis (nephritic syndrome)

Oedema, proteinuria, haematuria, renal failure

114

Chronic renal failure

Slow declining renal function

115

What part of kidney allows filtration?

Foot processes, endothelial cells and basement membrane in podocytes in glomerulus i

116

Blood flow in kidney

Renal artery > afferent arterioles > glomerulus > efferent arteriole > proximal convoluted tubule (PCT) > loop of hence > distal convoluted tubule > collecting duct/renal vein

117

Immunological causes of damage to BM

- Circulating immune complexes deposit in glomerulus
- Circulating antigens deposit in glomerulus
- Antibodies to BM/other components of glomerulus

118

Immunological causes of damage to BM damage the glomeruli via

Complement activation, neutrophil activation, reactive oxygen species, clotting factors

119

Non-Immunological causes of damage to BM > GD

- Hyperglycaemia
- Inherited disease (abnormal podocytes)
- Deposition of abnormal proteins (amyloid)

120

Non-Immunological causes of damage to vessels > GD

Injury to endothelium of vessels

121

Ischaemic mechanisms of tubular damage

Hypotension, damage to vessels within kidney, glomerular damage > reduced blood supply

122

Toxic mechanisms of tubular damage

Direct toxins, hypersensitivity reactions (to drugs), deposition of crystals in tubules (gout), deposition of abnormal proteins in tubules

123

Mechanisms of vascular damage

Hypertension, diabetes, atheroma, vasculitis, thrombotic microangiopathy (rare)

124

Vasculitis

Obliteration of lumen by inflammation, inflammation of larger arterioles > hypoxia, adults and children affected e.g. Wegener's granulomatosis

125

Thrombotic microangiopathy

Thrombi in capillaries and small arterioles, damage endothelium (bacterial toxins, drugs, abnormal clotting) e.g. haemolytic uraemic syndrome

126

Glomerular diseases

Membranous nephropathy (idiopathic)
FSGS (idiopathic)
Mesangiocapillary glomerulonephritis (idiopathic)
Minimal change disease
Post-infective glomerulonephritis
Anti-GBM disease
IgA nephropathy
Henoch-Schonlein purpura
Lupus nephritis (in SLE)

127

Cause of nephrotic syndrome

Damage to glomerulus

128

Symptoms of nephrotic syndrome

Oedema, proteinuria (>3g in 24hr), hypoalbuminaemia

(+/- hypertension, hyperlipidaemia)

129

Complications of nephrotic syndrome

Infection, thrombosis

130

Causes of nephrotic syndrome in Adults

Membranous nephropathy, focal segmental glomerulosclerosis, minimal change disease, diabetes, lupus nephritis, amyloid

131

Membrane nephropathy

Idiopathic, adults 30-60, M>F, 20-30% progress to end stage renal failure

132

FSGS

Idiopathic, genetic, heroin use, HIV, M>F

133

Minimal change disease

More common in children, biopsy is normal on light microscopy M=F

134

Causes of nephrotic syndrome in children

Minimal change disease (most common), FSGS

135

Acute nephritis symptoms

Oedema, haematuria, proteinuria, hypertension, acute renal failure

136

Causes of acute nephritis in adults

Post-infective glomerulonephritis, IgA nephropathy, vasculitis, lupus

137

Post-infective glomerulonephritis

Occurs few weeks after streptococcal throat infection, most recover completely

138

IgA nephropathy

Most common, teenagers and young adults with haematuria, 20-50% progress to renal failure over 20 years

139

Vasculitis symptoms

Fever, generally unwell, rash, myalgia, arthralgia (fever and weight loss due to inflammation)

140

Lupus

AI disease, typically young women

141

Causes of acute nephritis in children

Post-infective glomerulonephritis (most common), IgA nephropathy, Henoch-Schonlein purport, HUS

142

Henoch-Schonlein purpura

Specific type of IgA nephropathy, M>F, young boys/teenagers with arthralgia, ab pain, rash, haematuria, acute renal failure, most recover completely

143

Haemolytic-Uraemia syndrome

Typically children with E.Coli 0157 enteritis, acute nephritis, haemolysis, thrombocytopenia, children can be v.ill

144

Diagnosis of acute renal failure

Anuria/oliguria and raised creatinine and urea

145

Treatment of acute renal failure

Short term dialysis may be needed

146

Pre-renal causes of acute renal failure

Reduced blood flow to kidney - severe dehydration, hypotension (bleeding, septic shock, LV failure)

147

Post-renal causes of ARF

Tumours of urinary tract, tumours in pelvis, bladder stones, prostatic enlargement

148

Causes of ARF in adults

Vasculitis and acute interstitial nephritis/tubulointerstitial nephritis

149

Acute interstitial nephritis/tubulointerstitial nephritis

Tubular damage with inflammation, caused by drug reactions

150

Causes of ARF in children

Henoch-Schonlein purpura, HUS (gastroenteritis), Acute interstitial nephritis

151

Complications of acute renal failure

Cardiac failure (fluid overload), arrhythmia (electrolyte imbalance K), GI bleeding, Jaundice, Infection (lung and urinary tract)

152

What is chronic renal failure?

Permanently reduced GFR - reduced number of nephrons

153

Stage 1 CRF

>90

154

Stage 2 CRF

60-89

155

Stage 3 CRF

30-59

156

Stage 4

15-29

157

Stage 5

158

Common causes of CRF in adults

Diabetes (commonest), glomerulonephritis, reflux nephropathy

159

Reflux nephropathy

Chronic reflux of urine up the ureter > repeated infections and scarring of the kidney

160

Common causes of CRF in children

Developmental abnormalities, reflux nephropathy, glomerulonephritis

161

Effects of CRF

Reduced excretion of water and electrolytes (oedema/hypertension), reduced excretion of toxic metabolites, reduced production of erythropoietin (anaemia), renal bone disease

162

Myeloma

Tumour of plasma cells, produce large amounts of Ig, accumulate in kidney and block up glomeruli/tubules (irreversible)

163

Isolated haematuria causes

IgA nephropathy, thin basement membrane disease, Alport type hereditary nephropathy

164

Alport type hereditary nephropathy

Inherited abnormalities of collagen type IV > abnormal BM in glomerulus, eye and ear problems (deafness), autosomal/X-linked

165

Isolated proteinuria

Less than nephrotic range, without haematuria, renal failure/oedema

166

Isolated proteinuria benign causes

Postural, pyrexia, exercise

167

Isolated proteinuria causes in adults

FSGS, diabetes, lupus

168

Isolated proteinuria causes in children

Henoch-Schonlein purpura, FSGS

169

Pyelonephritis

Infection of kidney

170

Acute pyelonephritis

More common in women (ascending infection), instrumentation of urinary tract, diabetes, structural abnormalities

171

Complications of acute pyelonephritis

Abscess formation

172

Chronic pyelonephritis

Associated with obstruction of urinary tract and reflex of urine up ureter

173

Complications of chronic pyelonephritis

Scarring of kidney and chronic renal failure

174

Renal artery stenosis causes

Atheroma or material dysplasia

175

Renal artery stenosis complications

Ischaemia of affected kidney, activation of RAAS > hypertension, loss of renal tissue > reduced renal function

176

Hypertension

> Thickening of vessels walls and reduction in lumen > loss of renal tubules and renal function > activation RAAS > increases hypertension

177

Diabetes

- Hyperglycaemia damages BM, becomes thicker, glomerulus > excess ECM > nodules
- Damages small vessels > ischaemia and damage to renal tubules

178

Obstruction within lumen of urinary tract

Urinary calculi, strictures, neoplasia

179

Abnormalities of wall

Neoplasia, congenital anatomical abnormalities

180

External compression

Tumour outside urinary tract, inflammatory conditions (retroperitoneal fibrosis), pregnancy

181

Functional obstruction

Neurological conditions, severe reflux

182

Complications of obstruction

Infection (cystitis, ascending pyelonephritis), stone/calculi formation, kidney damage

183

Complete obstruction (acute) leads to

- Reduction if GFR > acute renal failure
- Mild dilatation and mild cortical atrophy

184

Partial/intermitten obstruction (chronic) leads to

- Continued GFR > dilatation of pelvis and calyces
- Filtrate passes back into interstitial > compression of medulla > impaired concentrating ability

Both leads to cortical atrophy, fall in renal filtration and renal failure

185

Clinical features of acute bilateral obstruction

Pain, acute renal failure and anuria

186

Clinical features of chronic unilateral obstruction

Asymptomatic > cortical atrophy and reduced renal function

187

Clinical features of bilateral partial obstruction

Initially polyuric, progressive scarring and impairment

188

Epidemiology of renal calculi/urolithiasis

7-10% population, male, 20-30

189

Pathogenesis of renal calculi

- Excess of substances precipitate out
- Change in urine constituents
- Poor urine output (supersaturation)
- Decreased citrate levels

190

Calcium stones form because

Hypercalcaemia (bone disease, PTH excess, sarcoidosis), excessive absorption of intestinal Ca, inability to reabsorb tubular Ca, idiopathic, gout, hyperoxaluria (excess dietary intake)

191

What are calcium stones formed of?

Calcium oxalate/phosphate

192

Struvite stones form because

Urease producing bacterial infection (increase pH - ammonia), precipitation of magnesium, ammonium, phosphate salts

193

Characteristics of struvite stones

Large staghorn calculi

194

Urate stones form because

Hyperuricaemia (gout/patient with high cell turnover -leukaemia), idiopathic

195

Cystine stones form because

Inability of kidneys to reabsorb amino acids (rare)

196

Investigations for renal calculi

Non-contrast CT, USS, IV urography

197

Complications of stones

Obstruction, haematuria, infection, squamous metaplasia (SCC)

198

Vast majority or renal carcinomas are

Clear cell (papillary and chromophobe)

199

Peak age for renal cell carcinoma

65-80

200

Male/female more likely to get renal cell carcinoma?

Male > female (3:2)

201

Risk factors for renal cell carcinoma

Tobacco (main), obesity, hypertension, oestrogen, acquired cystic kidney disease (chronic renal failure), asbestos exposure

202

Von Hippel-Lindau syndrome

Most common cancer syndrome in RCC, VHL gene required for breakdown of hypoxia inducible factor-1 (HIF-1) oncogene, loss of gene function > cell growth and increased cell survival

203

Where do tumours develop in Von Hippel-Lindau syndrome

Kidneys, blood vessels, pancreas

204

Presentation of RCC

Haematuria, palpable abdominal mass, costovertebral pain, paraneoplastic syndromes

205

Paraneoplastic syndrome

Clinical syndrome caused by tumours, not related to the tissue that tumour arose from, not related to invasion by tumour itself/metastases

206

3 paraneoplastic syndromes associated with RCC

- Cushing's syndrome (ACTH)
- Hypercalacaemia (PTH related peptide)
- Polycthaemia (eryhtropoietin)

207

Morphology of RCC - clear cell

Well defined, yellow tumours, haemorrhagic areas, > perinephric fat/into renal vein

208

Morphology of RCC - papillary

More cystic, more likely to be multiple

209

Microscopy of RCC - clear cell

Clear cells, dedicated vasculature, small bland nuclei

210

Microscopy of RCC - papillary tumours

Cuboidal, foamy cells, surrounding fibrovascular cores, containing foamy macrophages/calcium

211

Prognosis of RCC

5yr survival 45%, organ confined >70%, tumours in perinephric fat/renal vein 50%

212

Urothelial cell carcinoma

95% bladder tumours, arising from specialised multilayered epithelium, may arise renal pelvis > urethra

213

Urothelial cell carcinoma risk factors

Age, male, carcinogens (smoking, arylamines, cyclophosphamide, radiotherapy)

214

Urothelial cell carcinoma presentation

HAEMATURIA, urinary frequency, pain on urinary, urinary tract obstruction

215

Histological patterns of Urothelial cell carcinoma

1. Papilloma-papillary carcinoma
2. Flat non-invasive carcinoma
3. Invasive papillary carcinoma
4. Flat invasive carcinoma

216

Urothelial cell carcinoma prognosis

Recurrences are common, low grade 98% still alive at 5 years, stage muscle invasions 60%

Decks in Clinical Pathology Class (60):